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Substance-induced psychotic disorders (SIPD) are frequent and account for about 25% of the first admissions to a psychiatric hospital. From a clinical point of view the differential diagnosis of SIPD vs. primary (genuine or cryptogenic) psychotic disorders is often a challenge due to the similar psychopathology. This is complicated by the fact that SIPDs associated with cannabis, hallucinogens and amphetamines have a significant risk of transition to manifest psychotic disorder (e.g. schizophrenia). In the first section of this paper two case reports from general psychiatric and forensic practice are presented. Then, in a narrative review the relevance of the differential diagnostic distinction between both disorders is examined from the perspective of general and forensic psychiatry with respect to therapy, prognosis and judicial decisions regarding the placement in forensic commitment (§ 63 vs. § 64 German Penal Code, StGB). The last section aims to develop a structured procedure for the differentiation between SIPD and primary psychotic disorders. The concepts and findings presented and discussed in this paper are intended to help psychiatrists and psychologists make a diagnosis in a general and a forensic context.

In response to the coronavirus pandemic, most universities implemented digital teaching at short notice for the summer semester 2020 (SS20), whereas they simultaneously shut down classroom teaching. In the psychiatric clinic of the University Medical Center Göttingen, students' ratings concerning the learning effect and their substantive assessment for both forms of teaching were comparatively evaluated to determine the quality of this process.

Overall, 350students who had visited classroom teaching (winter semester, WS18/19 to WS19/20) vs. digital teaching (SS20) assessed their form of teaching post hoc, within astandardized survey. They rated the individual learning effect in seven psychiatric subjects and did asubstantive assessment on eight dimensions. In addition, they rated their expenditure of time.

For digital teaching, the individual learning effect was rated as either being equivalent or superior (subjects psychotherapy, schizophrenia). Despite asignificantly heightened expenditure of time, digital teaching was substantively assessed as being equivalent to classroom teaching or superior (dimensions independent processing of learning goals, overall format of lecture). Concerning their anticipated preparation for the professional practice, students rated digital teaching as being inferior to classroom teaching.

Apandemic-driven conversion from classroom to digital teaching did not result in aloss of quality on the dimensions measured in this comparative evaluation. With aview to professional practice, digital teaching should complement classroom teaching and be part of future curricula.

A pandemic-driven conversion from classroom to digital teaching did not result in a loss of quality on the dimensions measured in this comparative evaluation. With a view to professional practice, digital teaching should complement classroom teaching and be part of future curricula.

Multiple sclerosis (MS) is adisease continuum from a clinically isolated syndrome through relapsing remitting MS to secondary progressive MS (SPMS). There are numerous therapeutic approaches with proven efficacy on relapse and focal inflammatory disease aspects, whereas treatment of secondary progression and associated neuropathological aspects continues to be achallenge.

Overview of the current options for disease-modifying treatment of SPMS.

Results of randomized clinical trials are presented and evaluated on asubstance-specific basis.

Randomized SPMS trials showed inconsistent results regarding disability progression for beta interferons and negative results for natalizumab. Oral cladribine and ocrelizumab reduced disability progression in relapsing MS but have not been specifically studied in an SPMS population. Positive results for mitoxantrone are only partially applicable to current SPMS patients. For siponimod, asubstance that crosses the blood-brain barrier, the EXPAND trial demonstrated asignificant reduction in the risk of disability progression in typical SPMS. Subgroup analyses suggest ahigher efficacy of siponimod in younger patients with active SPMS.

There is limited evidence for the use of previously available disease-modifying treatment in SPMS. Siponimod represents anew therapeutic option for active SPMS, defined by relapses or focal inflammatory MRI activity. To establish the therapeutic indications for siponimod, early detection of relapse-independent progression as well as differentiation of active SPMS from inactive disease are of critical importance.

There is limited evidence for the use of previously available disease-modifying treatment in SPMS. Siponimod represents a new therapeutic option for active SPMS, defined by relapses or focal inflammatory MRI activity. To establish the therapeutic indications for siponimod, early detection of relapse-independent progression as well as differentiation of active SPMS from inactive disease are of critical importance.

The aim of the present study was to trace knee position at the time of bone bruise (BB) and investigate how much this position departed from the knee biomechanics of an in vivo flexion-extension.

From an original cohort of 62 patients, seven (11%) presented bicompartmental edemas and were included in the study. 3D models of bones and BB were obtained from MRI. Matching bone edemas, a reconstruction of the knee at the moment of BB was obtained. For the same patients, knee kinematics of a squat was calculated using dynamic Roentgen sterephotogrammetric analysis (RSA). Data describing knee position at the moment of BB were compared to kinematics of the same knee extrapolated from RSA system.

Knee positions at the moment of BB was significantly different from the kinematics of the squat. In particular, all the patients' positions were out of squat range for both anterior and proximal tibial translation, varus-valgus rotation (five in valgus and two in varus), tibial internal-external rotation (all but one, five externally and one internally). A direct comparison at same flexion angle between knee at the moment of BB (average 46.1° ± 3.8°) and knee during squat confirmed that tibia in the former was significantly more anterior (p < 0.0001), more externally rotated (6.1 ± 3.7°, p = 0.04), and valgus (4.1 ± 2.4°, p = 0.03).

Knee position at the moment of Bone bruise position was out of physiological in-vivo knee range of motion and could reflect a locked anterior subluxation occurring in the late phase of ACL injury rather than the mechanism leading to ligament failure.

Level IV.

Level IV.

Due to various functional impairments after primary extensor tendon repair or lack of treatment, secondary tendon reconstruction is often required. Anatomical considerations, the outcome of the injury and its treatment and the patients' individual demands on the function of the hand affect the choice of the procedure.

Description of techniques for secondary reconstruction after extensor tendon injury in zonesV-VII.

Overview of surgical treatment concepts for secondary extensor tendon repair in zonesV-VII of the extensor tendons of the fingers and thumb. Discussion of alternative surgical techniques for secondary extensor tendon repair.

While techniques for reconstruction of sagittal band injuries are predominant in zoneV, side-to-side tendon transfers, the use of tendon grafts and end-to-end tendon transfers prevail in zonesVI-VII. The reconstruction of the extensor pollicis longus tendon function using transfer of the extensor indicis proprius tendon is the standard procedure.

For secondary repair of an extensor tendon function, anatomical features and functional interaction of the extrinsic and intrinsic hand musculature need to be considered depending on the zone affected.

For secondary repair of an extensor tendon function, anatomical features and functional interaction of the extrinsic and intrinsic hand musculature need to be considered depending on the zone affected.

Pelvic fractures are typical for frail geriatric patients. They are characterized by increasing pain and loss of mobility. As geriatric pelvic fractures differ from the typical high velocity injuries, Rommens and Hofmann recommended anew classification for fragility fractures of the pelvis (FFP) in 2013. In addition to the location of the fracture they also assessed the degree of dislocation.

Compared to known fracture classifications of the pelvis, the FFP classification appears complex. Therefore, this study was designed to investigate the interobserver reliability of the FFP classification.

The members of the Section of Geriatric Traumatology (DGOU) were presented with 10 DICOM data sets with fractures of the pelvis for classification. As a reference the classification of P.M.Rommens, the author of the FFP, was established.

In this study 24consultants (47%) and 27(53%) residents took part. Also, six radiologists were invited to participate. Atotal of 493 assessments were made. In 184 (37%) cases thfication levels. In the end, however, the FFP classification is the only one that meaningfully represents pelvic fractures of geriatric and frail patients. By simplifying to the four main groups, a better interobserver reliability is achieved. For a successful treatment, however, attention to the individual patient and the "fracture personality" is essential.Extensor tendon injuries of the thumb include lesions of the tendons of the extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus muscles. The latter is practically only affected in open injuries. Open injuries require a tendon reconstruction by suture followed by immobilization in the distal and an adequate aftercare depending on the zone of injury. In distal injuries static splinting is applied, whereas proximal injuries from T4 on require a dynamic after-treatment. Different courses of the tendon of the extensor pollicis brevis muscle exist distal to the metacarpophalangeal joint and must be considered. The rare ruptures of the extensor hood at the metacarpophalangeal joint provoke an ulnar displacement of the extensor pollicis longus or both extensor tendons with concomitant lack of active extension in the metacarpophalangeal and interphalangeal joints. This injury is often misdiagnosed as a rupture of the ulnar collateral ligament of the metacarpophalangeal joint. It should be treated by refixation of the ruptured structures. https://www.selleckchem.com/products/dotap-chloride.html Closed chronic ruptures of the extensor pollicis longus tendon go along with a defect that requires a tendon transfer or a tendon autograft.

The long-term impact of transient ischaemic attack is largely unknown.

To assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).

A retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.

Most self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.